Quality Improvement Services, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH.
J Pediatr. 2013 Dec;163(6):1638-45. doi: 10.1016/j.jpeds.2013.06.031. Epub 2013 Jul 30.
To evaluate the effectiveness of a hospital-wide initiative to improve patient safety by implementing high-reliability practices as part of a quality improvement (QI) program aimed at reducing all preventable harm.
A hospital wide quasi-experimental time series QI initiative using high-reliability concepts, microsystem-based multidisciplinary teams, and QI science tools to reduce hospital acquired harm was implemented. Extensive error prevention training was provided for all employees. Change concepts were enacted using the Institute for Healthcare Improvement's Model for Improvement. Compliance with change packages was measured.
Between 2010 and 2012, the serious safety event rate decreased from 1.15 events to 0.19 event per 10 000 adjusted hospital-days, an 83.3% reduction (P < .001). Preventable harm events decreased by 53%, from a quarterly peak of 150 in the first quarter of 2010 to 71 in the fourth quarter of 2012 (P < .01). Observed hospital mortality decreased from 1.0% to 0.75% (P < .001), although severity-adjusted expected mortality actually increased slightly, and estimated harm-related hospital costs decreased by 22.0%. Hospital-wide safety climate scores increased significantly.
Substantial reductions in serious safety event rate, preventable harm, hospital mortality, and cost were seen after implementation of our multifaceted approach. Measurable improvements in the safety culture were noted as well.
通过实施高可靠性实践作为质量改进（QI）计划的一部分，评估一项全院范围的主动行动，以提高患者安全性，该计划旨在减少所有可预防的伤害。
实施了一项全院范围的准实验性时间序列 QI 主动行动，该行动使用高可靠性概念、基于微系统的多学科团队和 QI 科学工具来减少医院获得的伤害。为所有员工提供了广泛的错误预防培训。使用改善医疗国际研究所的改进模型来实施变革理念。衡量了对变革方案的遵守情况。
在 2010 年至 2012 年间，严重安全事件发生率从每 10000 个调整住院日 1.15 次事件降至 0.19 次事件，减少了 83.3%（P<.001）。可预防伤害事件减少了 53%，从 2010 年第一季度的每季度 150 次峰值降至 2012 年第四季度的 71 次（P<.01）。观察到的医院死亡率从 1.0%降至 0.75%（P<.001），尽管经过严重程度调整的预期死亡率实际上略有上升，估计与伤害相关的医院成本下降了 22.0%。全院安全氛围评分显著提高。
在实施我们的多方面方法后，严重安全事件发生率、可预防伤害、医院死亡率和成本大幅降低。还注意到安全文化方面有可衡量的改善。
